Suicide At Life's End Is A Slippery, Messy Slope

By PETER WOLFGANG | COMMENTARYThe Hartford Courant

There is little dignity in killing yourself with prescribed medication from a doctor.

Contrary to the image of peacefully resting in a chair or bed, surrounded by loved ones, after ingesting drugs prescribed by a trusted physician, the reality of physician-assisted suicides can be grim. Accounts of frantic relatives calling 911, hospitalization, vomiting and choking, panic attacks, terror and drug-induced assaultive behavior during physician-prescribed (and unattended) suicides have all been documented in the New England Journal of Medicine and other publications.

Nevertheless, a "right-to-die" bill has been introduced and will be considered during the current session of the General Assembly. The law would make it legal for doctors in Connecticut to give terminally ill people lethal medicine to end their lives. A similar proposal was killed in committee in 2009.

Oregon has a law that permits doctors to prescribe lethal doses of drugs to be self-administered. Their official reports are touted, but only include data voluntarily submitted by the prescribing physicians and not physicians or persons in attendance at the time of death.

Understandably omitted from these self-reports are instances when a doctor didn't take all the legally required measures to ensure mental capacity, persuasion from well-meaning but unobjective relatives, or deaths that required bystander assistance.

At least one study from the Netherlands (which has far more experience than Connecticut or even Oregon with physician-assisted suicide) reports that in at least 18 percent of physician-assisted suicides, doctors felt compelled to intervene and administer a lethal injection themselves because of complications. To what fate are we subjecting the weakest of Connecticut citizens when well-intentioned advocates portray drugs as an easy street to ending difficulty and pain?

Take also the very public case of Kate Cheney in Oregon. A woman who was declined death-inducing drugs by her physician, her psychiatrist and then a psychologist, in part because she seemed coached by her daughter and never articulated a direct request to kill herself with drugs. She was eventually granted drugs through the efforts of a "managed care ethicist" and died.

"Physician shopping" is an undignified and problematic practice not detected by Oregon's official reports. Yet it exists whenever someone is determined enough, through compassion or otherwise, to facilitate death.

America is embarking on a major effort to reorganize the delivery of health care in a way that hopes, in part, to contain the cost of medicine. Many Connecticut agencies are working hard to help facilitate these laws. Now is not the time to eliminate long-standing patient and societal protections against cheaply produced lethal drugs.

In 2008, in Oregon, patients were notified by letter that, unfortunately, their physician-recommended course of treatment was not covered under their state-funded prescription plan, but — wait for it — in the very same letter they were told that the relatively inexpensive drugs necessary for assisted suicide were covered. Suicide advocates retort that nobody was actually hurt by the plan or these letters. But as is apparent, eliminating proscriptions against prescribing suicidal medications leads even well-intentioned health administrators who are ensconced and driven to reduce costs to encourage their use.

Connecticut can avoid these missteps by upholding strong ethical traditions against doctor-prescribed "easy" and cheap remedies for pain and discomfort and instead focus its limited legislative resources on the funding of cutting-edge pain management techniques or including group mental health management as part of any health care restructuring. There are these and many other truly compassionate alternatives to simply dismissing the weakest among us with the false promise of an easy death.

No one supports keeping a terminally ill patient alive by extraordinary means against that patient's will. However, adoption of physician-assisted suicide will very likely open up a Pandora's box over how the sick, elderly and disabled in our society will be viewed and treated by family, the medical community and the state in the future.

Peter Wolfgang is executive director of the Family Institute of Connecticut.